阿德福韦酯治疗HBeAg阳性慢性乙型肝炎疗效及其与血清TNF-α变化的关系

Study on Efficacy of Adefovir dipivoxil in HBeAg-positive Chronic Hepatitis B Patients and its Correlation with Serum Levels of Tumor Necrosis Factor α

目的分析阿德福韦酯(ADV)治疗HBeAg阳性慢性乙型肝炎(CHB)的疗效及其与血清TNF-α水平变化的关系。方法对203例HBeAg阳性CHB患者采用ADV(名正)10mg/d治疗48周,观察24周和48周疗效,包括HBVDNA转阴、ALT复常、HBeAg转阴及血清转换、应答率,并用ELISA测定基线及48周血清TNF-α水平。结果 203例患者24周和48周HBVDNA转阴率、ALT复常率、HBeAg转阴率及血清转换率、应答率分别为31.5%、59.1%、15.8%、8.9%、13.3%和58.6%、78.3%、29.6%、16.7%、25.6%。24周和48周HBVDNA载量较基线下降的中位值分别是3.56log10拷贝/毫升和4.35log10拷贝/毫升,且48周疗效均优于24周(P<0.05),而除HBVDNA未转阴组、ALT未复常组外,余疗效组TNF-α水平在48周较基线均下降明显(P<0.001)。结论 HBeAg阳性CHB患者ADV治疗48周能够有效地抑制HBV,降低血清TNF-α水平。

Objective To investigate the efficacy of Adefovir dipivoxil in HBeAg - positive chronic hepatitis B（CHB） patients and study its correlation with serum levels of tumor necrosis factor α. Methods 203 HBeAg - positive CHB patients were recruited into the study and were administered with ADV（Minzhen） 10mg once daily for 48 weeks. The efficacy including HBV DNA negativity,alanine aminotransferase（ALT） normalization, HBeAg loss and seroconversion, and response at the treatment times of 24 and 48 weeks were observed. The serum levels of TNF - α at baseline and week 48 were examined by enzyme linked immunosorbent assay. Results The rate of HBV DNA negativity,ALT normalization, HBeAg loss and seroconversion, and response in patients at the treatment times of 24 and 48 weeks were 31.5% , 59.1% , 15.8% , 8.9% , 13.3% and 58.6% , 78.3% , 29.6% , 16.7% , 25.6% respectively. And meantime the median reduction in serum HBV DNA loads was 3. 56log10 and 4. 35log10copies/ml respectively. Furthermore the therapeutic effects at week 48 were all considerably better than those at week 24 （ P 〈 0.05 ）. There were lower serum levels of TNF-α at week 48 than before treatment in different therapeutic effect groups,which had statistic difference （P 〈 0.001 ）. Conclusion ADV can effectively inhibit the copy of HBV,depress serum levels of TNF -α during the treatment times of 48 weeks in patients with HBeAg - positive chronic hepatitis B.